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      The nutrition transition and its health implications in lower-income countries

      Public Health Nutrition

      CABI Publishing

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          Abstract

          Objective:

          This article reviews information on the rapid changes in diet, activity and body composition that lower- and middle-income countries are undergoing and then examines some of the potential health implications of this transition.

          Design and Setting:

          Data came from numerous countries and also from national food balance (FAOSTAT) and World Bank sources. Nationally representative and nationwide surveys are used. The nationally representative Russian Longitudinal Monitoring Surveys from 1992–96 and the nationwide China Health and Nutrition Survey from 1989–93 are examined in detail.

          Results:

          Rapid changes in the structure of diet, in particular associated with urbanization, are documented. In addition, large changes in occupation types are documented. These are linked with rapid increases in adult obesity in Latin America and Asia. Some of the potential implications for adult health are noted.

          Conclusions:

          The rapid changes in diet, activity and obesity that are facing billions of residents of lower- and middle-income countries are cause for great concern. Linked with these changes will be a rapid increase in chronic diseases. Little to date has been done at the national level to address these problems.

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          Most cited references 21

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          Weight change and diabetes incidence: findings from a national cohort of US adults.

          To examine how long-term patterns of weight change affect the risk for diabetes, especially non-insulin-dependent diabetes mellitus, the authors examined the relation of weight change over a period of about 10 years (from the baseline examination in 1971-1975 until the first follow-up examination in 1982-1984) to the 9-year incidence of diabetes mellitus (1984-1992) in a national cohort of 8,545 US adults from the National Health and Nutrition Examination Survey Epidemiologic Followup Study. Diabetes incidence was identified from death certificates, hospitalization and nursing home records, and self-report. In this cohort, 487 participants developed diabetes. The hazard ratios were 2.11 (95% confidence interval (CI) 1.40-3.18) for participants who gained 5- < 8 kg, 1.19 (95% CI 0.75-1.89) for participants who gained 8- < 11 kg, 2.57 (95% CI 1.84-3.85) for participants who gained 11- < 20 kg, and 3.85 (95% CI 2.04-7.22) for participants who gained 20 kg or more compared with participants whose weights remained relatively stable. The authors found no evidence that the results differed by age, sex, or race. They estimated that the population attributable risk was 27% for weight increases of 5 kg or more. Results from this study and other recent studies suggest that the increase in body mass index in the United States that occurred during the 1980s may portend an increase in the incidence of non-insulin-dependent diabetes mellitus with important public health consequences in future years.
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            Nutritional Patterns and Transitions

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              Birthweight and adult health outcomes in a biethnic population in the USA.

              Recent data indicate that low-birthweight adults are at a higher risk than their high-birthweight peers of developing ischemic heart disease or a cluster of conditions known as the IRS, which includes dyslipidaemias, hypertension, unfavorable body fat distribution and NIDDM. Thus far these observations have been limited to Caucasians from the United Kingdom. we extended these observations to a broader segment of the general population by studying the association of birthweight and adult health outcomes in a biethnic population of the United States. We divided a group of 564 young adult Mexican-American and non-Hispanic white men and women participants of the San Antonio Heart Study into tertiles of birthweight and compared metabolic, anthropometric, haemodynamic, and demographic characteristics across these tertile categories. Additionally, we studied birthweight as a predictor of the clustering of diseases associated with the IRS, defined as any two or more of the following conditions: hypertension, NIDDM or impaired glucose tolerance, dyslipidaemia. Normotensive, non-diabetic individuals whose birthweight was in the lowest tertile had significantly higher levels of fasting serum insulin and a more truncal fat deposition pattern than individuals whose birthweight was in the highest tertile, independently of sex, ethnicity, and current socioeconomic status. Also, the odds of expressing the IRS increased 1.72 times (95% confidence interval: 1.16-2.55) for each tertile decrease in birthweight. These findings were independent of sex, ethnicity, and current levels of socioeconomic status or obesity. In conclusion, low birthweight could be a major independent risk factor for the development of adult chronic conditions commonly associated with insulin resistance in the general population.
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                Author and article information

                Journal
                Public Health Nutrition
                Public Health Nutr.
                CABI Publishing
                1368-9800
                1475-2727
                March 1998
                March 01 1998
                March 1998
                : 1
                : 1
                : 5-21
                Article
                10.1079/PHN19980004
                10555527
                © 1998

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